Healthcare Provider Details

I. General information

NPI: 1407769508
Provider Name (Legal Business Name): PRISM HEALTH & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 COLLEGE AVE STE G
ALTON IL
62002-4707
US

IV. Provider business mailing address

2710 COLLEGE AVE STE G
ALTON IL
62002-4707
US

V. Phone/Fax

Practice location:
  • Phone: 314-669-5215
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: CODY PALMER
Title or Position: APRN/OWNER
Credential: DNP, APRN
Phone: 618-335-2575